Provider Demographics
NPI:1154796563
Name:MICHELLE WOODARD M.D LLC
Entity type:Organization
Organization Name:MICHELLE WOODARD M.D LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-705-6070
Mailing Address - Street 1:2410 HOG MOUNTAIN RD STE 303
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4850
Mailing Address - Country:US
Mailing Address - Phone:706-705-6070
Mailing Address - Fax:706-705-6075
Practice Address - Street 1:2410 HOG MOUNTAIN RD STE 303
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4850
Practice Address - Country:US
Practice Address - Phone:706-705-6070
Practice Address - Fax:706-705-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061022305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization